Nearly half -- 47% -- of hospital and health system leaders are "somewhat confident" of their ability to meet the Meaningful Use stage 2 requirements, according to a new KPMG survey. The respondents included 140 healthcare executives who completed a webcast poll.

In addition, 36% of the survey respondents said they were "confident," 4% said they weren't confident at all, and 11% didn't know what their level of readiness was to meet the criteria, which are part of the government's electronic health records (EHR) incentive program.

When asked to identify the biggest challenge in complying with the standards, the largest group of respondents (29%) cited training and change management. Nineteen percent said the most daunting challenge was a lack of monitoring processes to help ensure sustained demonstration of Meaningful Use.

Another 19% of the surveyed executives viewed the ability to capture relevant data electronically in the clinical workflow as a major problem. The American Hospital Association (AHA) and the College of Health Information Management Executives (CHIME) have pointed out that quality reporting, in particular, has been very difficult in stage 1.

Other challenges cited by the respondents were lack of a dedicated Meaningful Use team (12%) and availability of certified EHR technology from current vendors (6%).

Security and privacy criteria in both Meaningful Use stage 2 and HIPAA were also on the minds of healthcare executives. Forty-seven percent said they were only somewhat comfortable with their organizations' ability to comply with all parts of HIPAA, including new annual risk assessments. Eight percent said they were not comfortable at all, 13% said they weren't sure and 31% felt confident of their ability to meet security requirements.

A majority of respondents said their organizations were adding or tapping new resources to help with the implementation and deployment of EHRs. Thirty percent of respondents said their organization had hired new or additional staff to complete EHR deployment, while another 22% said they'd secured third-party assistance.

The survey didn't reveal how many of these organizations obtained outside assistance while also adding IT staff. "It reflects that at least 50% of respondents got some kind of help," said Jerry Howell, a principal in KPMG's healthcare consulting practice, in an interview with InformationWeek Healthcare.

Howell said he and his colleagues weren't surprised that so many respondents saw training and change management -- rather than technical aspects of implementation -- as their top challenges in Meaningful Use stage 2. "We always felt reasonably confident that the leading software vendors would successfully create the technology capabilities to meet the Meaningful Use requirements," he said. Also, he noted, the transition from stage 1 to stage 2 is mainly about "using the technology effectively. That's contingent on the processes and people being right, which is all about change management."

An organization's ability to sustain Meaningful Use, he said, concerns some leaders because "it's a self-administered program at this point, and there's some concern about the unknown. Also, our hospitals have struggled with the reporting, and it's not clear how rigorous the audit processes are. So it's more of a fear about what they don't know than a fear of not doing it right."

Healthcare IT leaders must also balance their Meaningful Use effort against other demands on their time and resources, such as ICD-10, preventing readmissions and new care delivery models. "The Meaningful Use initiative is one of three or four really critical initiatives that hospitals are facing, so that intensifies the challenge," Howell pointed out. "There's also some degree of EHR fatigue. Many are eager to get this done and move on to all the things they need to do with this data."

However, he added, EHR implementation never really ends. There are always new updates and new ways to optimize the use of the systems. Moreover, hospital consolidation and the addition of physician practices to healthcare organizations present new challenges in health IT.

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